Original Article Awareness of and Attitude towards Glaucoma among an Adult Rural Population of Osun State, Southwest Nigeria Michaeline A. Isawumi, Mustapha B. Hassan, Patience O. Akinwusi1, Olalekan W. Adebimpe2, Esther O. Asekun‑Olarinmoye2, Alebiosu C. Christopher1, Taiwo A. Adewole3

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ABSTRACT Purpose: To obtain baseline data and assess the level of awareness and attitudes towards glaucoma among rural communities of Osun State, Nigeria. Materials and Methods: This was a community-based study that involved interviews and descriptive cross-sectional analysis. Serial‑recruitment was performed of consenting participants who presented at a community‑based screening service in March 2011. Socio‑demographic data and information about glaucoma were obtained through face‑to‑face semi‑structured questionnaires. Results: The study population comprised 259 respondents (mean age 49.73 ± 16.6 years; range 18 to 90 years). There were 159 females (61.4%). Skilled workers were the most common 130/259 (50.3%) participants. Only 41 (15.8%; 95% CI: 11.4‑20.2) participants had ever heard of glaucoma. Sources of information were from visits to an eye clinic for 21/41 (51.2%; 95% CI: 35.9‑66.5) participants and 15/41 (36.6%) participants who know someone with glaucoma. Reponses to the causes of glaucoma included 20/41 (48.8%; 33.5‑64.1) participant who said ‘I don’t know’ and 24.4% of participants who responded ‘curse‑from‑God’. Responses to questions on treatment included 20/41 (48.8%) participants who responded ‘I don’t know how it can be treated’ and 10/41 (36.6%) said ‘medically’. Thirty 30/41 (73.2%) participants would refuse surgery, half of them because ‘it cannot cure or reverse the disease’ while (26.7%) would refuse out of ‘fear’. Only 8/41 (19.5%; 95% CI: 7.4‑31.6) would accept surgery for maintenance. Statistically significant predictors of glaucoma awareness were older participants, males and skilled workers (teachers) (P = 0.028, P = 0.018, P = 0.0001, respectively). Conclusions: The outcomes of study indicate a low level of awareness of glaucoma. Health education at all levels of health and eye care services is required to prevent ocular morbidity and irreversible blindness from glaucoma.

Website: www.meajo.org DOI: 10.4103/0974-9233.129769 Quick Response Code:

Key words: Adults, Attitudes, Awareness, Glaucoma, Rural

INTRODUCTION

G

laucoma is a group of diseases characterized by progressive optic neuropathy and characteristic changes and loss in visual field. More recently it has been described as a neurodegenerative disorder of the optic nerve with acquired loss of retinal ganglion cells.1 It is the 2nd most common cause of

blindness in Nigeria and worldwide. Glaucoma constituted 0.7% and 0.4% among the blind in Nigeria and the Southwest region, respectively, out of 13,599 individuals aged 40 years or older who were examined.2,3 It is 2nd only to cataract.2,3 Glaucoma is also the most common cause of functional low vision in Nigeria.4 Similar to Nigeria, glaucoma is the 2nd leading treatable cause of irreversible blindness in south India.5

Department of Surgery, Ophthalmology Unit, 1Department of Medicine, 2Department of Community Medicine, 3 Department of Biochemistry, College of Health Sciences, Osun State University, Oke‑Baale, Osogbo, Nigeria Corresponding Author: Dr. Michaeline A Isawumi, Department of Surgery, Ophthalmology Unit, College of Health Sciences, Osun State University. PMB 4494, Osogbo Osun State, Nigeria. E‑mail: [email protected]

Middle East African Journal of Ophthalmology, Volume 21, Number 2, April - June 2014

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Isawumi, et al.: Awareness and Attitudes to Glaucoma Among Rural Adults in Nigeria

Blindness from glaucoma can however be prevented if detected early and treated effectively. One of the methods for timely detection and treatment is by having regular eye “screening” during adulthood. This endeavor can be successful if there is awareness of glaucoma. The World‑Kidney‑Week and World‑Glaucoma‑Day presented an opportunity in 2011 for members of the College of Health Sciences, Osun State University to carry out screening. This disease is particularly important among individuals of African ancestr y, with a 3‑4 times higher prevalence and risk of developing blindness.6 Glaucoma has no specific symptoms or signs for the actual onset of disease or the period prior to clinical manifestation of the disease. Symptoms and signs at onset are what usually qualifies for complete screen‑able disease.7 Hence, it is important that awareness of glaucoma be raised among the public by all eye care as well as health workers. A previous study of hospital workers in western Nigeria showed that few people working in the eye department had awareness of some eye diseases.8 There is no known data on the level of awareness or attitudes of people in these communities and State to glaucoma. This study was performed to collect baseline data, as well as assessing the level of awareness and attitudes towards glaucoma in the rural communities of Osun State, Nigeria. The findings from this study may assist in planning for prevention of glaucoma‑related blindness.

MATERIALS AND METHODS Background

Patient screening was carried out at Alajue, a rural community in Ede South Local Government Area of Osun State and Ibokun, a sub‑urban community in Obokun Local Government Area of Osun State. Osun State is located in Southwest Nigeria. It has about 3 million people with rural dwellers as the majority. Farming is the major occupation. It lies in the rainforest belt of the country. Ladoke Akintola University Teaching Hospital (LTH) is located in Osogbo, the State capital. It provides training and specialized eye services to the people in the state and surrounding regions. Study design

This was a descriptive, cross‑sectional study to assess the level of awareness and attitudes to glaucoma among adults in the communities. Adults aged 18 years and above were eligible to be included. Study participants were serially recruited from adults who voluntarily presented for screening at the venue. All consenting adults were recruited into the study. Pre‑screening activities

Ethical clearance was first sought and obtained from the Research and Ethical Committee of the College of Health Sciences, Osun State University, Nigeria. The community leaders were subsequently approached. The purpose was to 166

mark the world glaucoma and world kidney days in 2011. The intention was to raise awareness of these non‑communicable diseases i.e., glaucoma and other eye diseases, kidney, and in addition hypertension and diabetes mellitus, so that morbidity from these diseases could be prevented. Secondly, there was a general health screening for these diseases and screening for glaucoma and other eye diseases. The advantages of the free health and eye screenings were discussed with all individuals who presented at the screening venue. The procedure for screening was explained to all individuals and they were assured that no harm would be caused. The community were informed by announcements in the churches, mosques, market days and through the town crier. Permission was sought to enter the community and a date was agreed upon after the community members were duly informed. Screening/survey activities

This study was performed over 2 days in March 2011. The first day was in Alajue and the second day in Ibokun. The screening was carried out at the community halls. Health talks were given on care of the eyes and common eye problems. There were 4 stations for the screening process. The first station had research assistants registering respondents as well as collecting the demographic data such as gender, occupation, age, and community. The second station was used to test aided and unaided visual acuity one eye at a time. Pinhole testing was performed for visual acuity less than 6/9. An improvement suggested refractive error. Visual acuity was measured by ophthalmic nurses. The third station had two resident ophthalmologists who administered a semi‑structured pre‑tested questionnaire by face‑to‑face interview. The questions covered the awareness of glaucoma, sources of information, causes, types of treatment and attitude to surgery. The fourth station had two ophthalmologists who examined the anterior and posterior segments of the eye. The instruments (ophthalmoscopes, tonometer) for examination were well calibrated prior to use to ensure valid results. Suspicious glaucomatous discs were classified as relative afferent pupillary defect (RAPD), cupping of the optic disc >0.6 and cupping in both eyes with asymmetry of >0.1. This group underwent applanation tonometry done using the hand‑held Perkins applanation tonometer. Intraocular pressures >21 mmHg was considered a glaucoma suspect. These subjects were sent for perimetry. The other eye diseases such as conjunctivitis were treated while conditions requiring surgery or follow‑up were referred to the base hospital. Data were managed using SPSS software version 15 (IBM Corp., New York, NY, USA). Consistency of data were checked by double entry and checking for outliers. Descriptive analysis was performed with derivation of proportions, 95% confidence interval (CI), mean and standard deviations. Test of significance was performed using bivariate analysis and Chi square test, and P 

Awareness of and Attitude towards glaucoma among an adult rural population of Osun State, Southwest Nigeria.

To obtain baseline data and assess the level of awareness and attitudes towards glaucoma among rural communities of Osun State, Nigeria...
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